{
"Npi": {
"NPI": "1205200359",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WEISZ",
"FirstName": "JENNA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "OTR/L",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "ERLANDSON",
"OtherFirstName": "JENNA",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "PO BOX 3201",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DICKINSON",
"MailingAddressStateName": "ND",
"MailingAddressPostalCode": "58602-3201",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "701-765-3064",
"MailingAddressFaxNumber": "701-483-3889",
"FirstLinePracticeLocationAddress": "870 PHEASANT RUN AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DICKINSON",
"PracticeLocationAddressStateName": "ND",
"PracticeLocationAddressPostalCode": "58601",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "701-710-0800",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/29/2015",
"LastUpdateDate": "04/14/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "225X00000X",
"TaxonomyName": "Occupational Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "103K00000X",
"TaxonomyName": "Behavior Analyst",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}